Wednesday, May 1, 2013

AL DRs Dodge Bullet ... This Time

In workers' compensation there's only one pot of money from which everything must get paid.

Consequently when one subject of workers' compensation is targeted to get more money, another subject is targeted to get less money.

In most attempts at "reform" the subject of more money is usually the claimant/employee, and quite often the subject targeted for reductions is the medical provider community.

That was tried in Alabama, but didn't quite make it this year.

Senate Bill 453, by Sen. Del Marsh, R-Anniston, failed to get enough votes to clear the Alabama's Senate Business and Labor Committee and is done for the year.

The bill would have increased the payment period for nonscheduled permanent partial disability awards from 300 weeks to 400 weeks, raised the maximum attorney fee from 15% to 20% and hiked burial expenses from $3,000 to $6,500. It would have also altered the formula used to calculate weekly PPD benefit rates and allowed workers with salaries above the state's average weekly wage to collect as much as $447.18 a week. Currently, the maximum weekly benefit is capped at $220 a week.

The increases would have come at the expense of medical treatment reimbursement.

Existing Alabama law caps medical reimbursements at the "prevailing rate," which requires consideration of "the most commonly occurring reimbursements for health services" procedure codes and use of assistant surgeons. SB 453 would have eliminated the "prevailing rate" language from Alabama's workers' compensation statutes and would have implemented firm caps detailed in the workers' compensation fee schedule.

It may have been that SB 453 could have survived except for the provision shifting control over the workers' compensation fee schedule from the Medical Services Review Board to the Alabama Department of Labor. Existing statutes give the Medical Services Review Board control over the fee schedule, which is comprised of five physicians.

The bill would have reduced representation on the Board from five physicians selected from a list of 15 submitted by the Medical Association of Alabama to 2 physicians, one appointed by the medical association, and another representative of hospital interests from the Alabama Hospital Association.

Al Henley, president of the Alabama AFL-CIO, told WorkCompCentral, "They omitted the medical community, who was (previously) allowed to be on the board to determine the rates. That is what had them fired up."

Alabama remains one of the few states left that pays doctors according to a prevailing rate.

I don't know if lawmakers in Alabama will revisit "reform" next year. My suspicion is that the issue is not dead.

The national trend is clearly towards fee schedules, and "guided" utilization practices (not to mention administrative adjudication of disputes). Eventually, states succumb to the prevailing trend because of the threat of competition for business, which means competition for jobs. And lawmakers need to retain and grow jobs in order to maintain the tax base.

Alabama's medical community dodged a bullet. The leaders will need to start bargaining now though, because clearly medical vendors are in the cross hairs of "reform" when it comes around in next year's session.

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